Inspection is negative in many cases of aneurism of the aorta, but in some abnormal pulsation or a diffuse heaving impulse may lie perceived, usually in the first or second right interspace. Throb bing may be seen at the sternal notch or in the neck when the innominate artery is involved. A tumor may be visible in front or in the rear, usually in the left scapular region.
Dyspno3a may be due to compression of the recurrent laryngeal nerves, of the trachea, or of the left bronchus.
Pressure on this nerve, especially on the left one, causes hoarseness and loss of voice. This may be due either to spasm or paralysis of the muscles of the left vocal cord. Abductor paralysis may be the only symptom of aneurism.
In the early diagnosis of aneurism of the arch of the aorta, attention is called to the fact that pressure upon the recur rent nerve from anctrism or thoracic tumor does not necessarily produce aphonia. The only subjective symptom of this stage may be a more or less con stant laryngeal cough. There may also be dyspncea from pressure on the bra chial plexus with consequent bron chial spasm. A frequent indication of aneurism of the aorta is pain in the region of the fifth cr sixth dorsal verte bra. Auscultaticn of the left interscapu lar space may reveal an arteriodiastolic murmur not heard elsewhere, or else a systolic murmur due to the beating of the aneurismal sac against the left bronchus. Another auscultatory phe nomenon is the presence of the systolic sound or thud in the brachial artery sim ilar to that observed in aortic insuffi ciency. W. Porter (N. V. Med. Jour., Dec. 9, '99).
Early diagnosis of aortic aneurism. Series of 54 cases in which 3S had paral ysis of the left recurrent laryngeal nerve. 5 of the right nerve, and only 1 of both nerves. in all these cases the patients first consulted the author on account of hoarseness. Tracheal buzzing was pres ent in 19 out of 31 eases. It is best felt when the cricoid cartilage is pushed up ward with the index and middle finger of the right band. the head of the patient being bent a little backward. A pulsa tion downward is felt which ought not to be confused with the general pulsa tory vibration of the larynx that occurs not infrequently in excited patients. Moritz Schmidt (Med. Chronicle, Mar., 1900).
liannorrhage from the air-passages may be produced in three ways: (a) by the formation of granulation tissue in the trachea where it is compressed, in which case the bleeding is not abundant; (b) by the sac breaking into the trachea or bronchi; (c) by the lung-tissue being eroded or perforated. A patient may re
cover and live for years even after pro fuse hwmorrhag.e occurring as the result of aneurism.
A relatively frequent phenomenon is repeated occurrence of Immoptysis pre ceding the opening of the sac into the bronchial tubes, dne to the existence of a small communication between the aneurism and the latter. Hampeln (Ber liner klin. Woch., Dec. 24, '94).
Dysphagia may be due to spasm of the msophagus or to compression. Perfora tion may be induced by the passage of an (esophageal Bougie. This instrument therefore should not be used.
Ascending Portion of the Arch.—Aneu risms in this region may be situated just above the sinuses of Valsalva, or some what higher, on the convex border of the ascending arch. In the former case they may be small and latent, and their rupture into the pericardium (usually causing instant death) be the first in dication of their existence. When this does not occur aneurisms in this region may become exceedingly large and pro ject into the right pleural cavity or for ward, after destroying the sternum and ribs.
[I witnessed and reported a case in which aneurism of the innominate artery was suspected and in which ligation of the carotid artery was practiced as a last resort, following the use of iodide of potash, digitalis, and continued digi tal pressure for thirty-six hours and mechanical pressure for one hundred and twenty hours. The patient died immediately upon the ligation of the carotid artery. A post-mortem exami nation showed that the aneurism was one involving the arch of the aorta and that coagulation bad resulted from the pressure, but not sufficient to occlude the vessel. J. MCFADDEN GASTON.] Aneurism probably arising from one of the pulmonary sinuses of Valsalva. Peculiar features noted: Development of the sac anterior and to the left of the sternum; the sac fills up a large portion of the upper half of the left thorax; absence of involvement of the vagus and recurrent laryngeal and of the sympathetic nerves; peculiar and unusual murmurs; absence of irregular and asynchronous action of the radial pulses; absence of tracheal tugging.